A man’s fall from a moped caused him much stranger trouble than anyone could have imagined. According to his doctors, a bruise near his genitals left him with a days-long erection—one that eventually required a trip to the emergency room to treat. Thankfully, doctors were able to resolve his awkward complication, and the patient had no lasting damage.
The bizarre tale was described by the UK doctors who treated the man, in a case study published last month in the journal Case Reports in Urology.
According to the report, the 35-year-old man had fallen off his moped nine days before his visit to the ER. At first, he only seemed to have bruised his perineum, the area between the genitals and anus that’s commonly known as the “taint.” Before long, though, the man developed an erection that lasted far, far longer than four hours. While the erection itself wasn’t painful and there were no other symptoms, he did have to deal with “mild discomfort on walking.”
Once at the ER, he was classified as having a Grade IV erection, the highest tally on the Erection Hardness Score, which is a real thing. Even among cases of unwanted stiffness, though, the man’s situation was unusual.
Around 95 percent of erections that last too long—a condition called priapism—involve a blockage of blood vessels directly connected to the penis. This type, called low-flow priapism, basically means that an erection is caused by blood that can’t leave the genitals as normal. Most cases of low-flow priapism are unexplained, but erectile dysfunction drugs and neurological conditions are common causes.
The man, however, had high-flow priapism, meaning that blood wouldn’t stop rushing to his genitals. As with his case, this type usually happens when the blood vessels surrounding the genitals are injured and ruptured through physical trauma. The physical trauma created a pooling of blood in the area and two fistulas on the left and right side of his genitals—connections that redirected the pooled blood to the vessels that regulated his erection.
Low-flow priapism is usually a medical emergency, since the blockage can kill off tissue and permanently damage the penis if left unresolved past a few hours. But cases of high-flow priapism are much less dangerous and usually painless. Often times, doctors recommend only conservative treatment, involving little more than an ice-pack and compression of the affected blood vessels. And around 60 percent of cases resolve on their own without any other treatment.
The man, however, opted for a more aggressive procedure. Using a catheter to carefully pick out the arteries directly feeding the erection, the doctors created their own blood clots near each fistula. For one fistula, they used a gel-like foam that breaks down on its own within four to six weeks; for the other, they used a microcoil specifically designed to block a single blood vessel.
Soon after, the man’s condition improved, though it took a while for him to fully recover the use of his penis. But when they checked in on him a year later, he reported having completely normal erectile function.
Quirky as the case is, the doctors do think there’s an important lesson to be learned. Some doctors have been reluctant to treat these cases with the methods used by this team, at least at first, over worries that they could inadvertently cause lasting damage to the penis. But high-flow priapism, even if not life-threatening, can also lead to long-term erectile dysfunction if it doesn’t clear up on its own fast enough. So while doctors do need to weigh the risks and benefits of each approach, the authors say their case highlights the value of treating the condition as quickly as possible.
“Timely intervention needs to be considered to avoid the potential risk of erectile dysfunction in the long term from conservative measures,” they said.